Presentation (CTI)

OBJECTIVES: Depression substantially impairs health-related quality of life (HRQoL) in adolescents. Although emotion regulation strategies (ERS) are closely linked to depressive symptoms, direct evidence on their associations with HRQoL, particularly across different levels of depression severity, remains limited. This study aims to evaluate the associations of cognitive reappraisal (CR) and expressive suppression (ES) with HRQoL among Chinese adolescents with depression, and to assess whether these associations differ by depression severity.
METHODS: We conducted a cross-sectional analysis of 1,902 adolescents aged 10-19 years with depressive symptoms, recruited from nine provinces in China between February and March 2025. Depression severity and ERS were assessed using the Patient Health Questionnaire-9 and the Emotion Regulation Questionnaire. HRQoL was measured using the CHU9D and EQ-5D-Y-3L. Multivariable regression models were applied to examine associations between ERS and HRQoL, adjusting for demographic, social, academic, and lifestyle factors, and to test interactions with depression severity.
RESULTS: Participants had a mean age of 15.8 years, and 58.4% were female. Mean utility scores were 0.745 (CHU9D) and 0.904 (EQ-5D-Y-3L). Major depression was associated with significantly lower HRQoL than subthreshold depression (p < 0.001). After adjustment, higher CR use was associated with higher HRQoL (p < 0.001), with a stronger association observed in adolescents with major depression (interaction p < 0.01). Higher ES use was associated with lower CHU9D utility (p < 0.05) but not EQ-5D-Y-3L utility.
CONCLUSIONS: Promoting cognitive reappraisal may represent a practical strategy to improve HRQoL among adolescents with both subthreshold and major depression. The CHU9D appears more sensitive to mental health-related functional impairments than the EQ-5D-Y-3L.